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Td <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# 0 ) CIU � <br /> EHD RECEIVED APP.REFERRAL: -7 COMPLETE & SUBMIT BY <br /> DATE "" ���� DATE <br /> ojt <br /> ATTN: (r1[ r l M e tS <br /> SITE ADDRESS: �'�u <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e.: sewage disposal, <br /> water supplies, etc...). Where necessary, on an attached piece of plain paper, draw completed map of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> )/-- 0 0 <br /> 62. <br /> / r <br /> P/ZA Q ✓ . rL v' rt 46 k ;A a <br /> I recommend: Approval Denial Continuance Inspector's Signatur ,a.p/ 70'x-•*► <br /> k iskkkk4ekkkkitkkkkkir is is dekkkkkkisxkkkkis ie iekickkkkkkiekkkkkkx�r is iskk>c ie iekkiskis iekkkkkkiskkkkkkkkixkkkkkkkk <br /> Supervisor/Lead Senior Comments: <br /> a-rr <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> E1106 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />